“Today there is 30% of the Italian population, made up of elderly and frail people, who alone absorb 70% of the resources available for healthcare. And often they don’t even get a good service”, because in the ‘middle ground ‘ between the family doctor and the hospital he finds a black hole. For Fabrizio Pregliasco the evil that is killing the National Health Service it’s exactly this. The suffocating emergency rooms, the waiting lists that rob millions of sick people of the constitutional right to health, the flight of doctors, the exasperation of nurses are all symptoms of this evil, side effects produced by “desert of intermediate services“. We can and must repopulate it, he maintains, by tightening “avirtuous alliance between public and private. Only together can we do it.”
Pregliasco is not just the doctor who gives the flu numbers, a virologist among the most present in the media before, during and after the Covid pandemic. In Milan he is director of the School of Specialization in Hygiene and Preventive Medicine at the State University and medical director of the Irccs Galeazzi-Sant’Ambrogio hospital. He was president of Anpas (National Association of Public Assistance), health director of the Sacra Famiglia Onlus Foundation of Cesano Boscone, on the outskirts of the Lombardy capital, and consultant to Pio Alberto Trivulzio. The ‘Baggina’ of the Milanese overwhelmed by the coronavirus tsunami. It is in all these guises, more than that of ‘virostar’, that he delivers his reflections on the difficulties of a NHS on red alert. According to many, life-threatening.
“There is definitely an important need for increase in healthcare spending and staffing – he stated – there is a need to reduce waiting lists acting above all on the lever of prescriptive appropriateness”, because “the increase in slots – he warns – in and of itself would be a hot topic. There is yes from stem the escape of lab coatsto fight the intolerable scourge of violence in the wards”, but much of the work to be done, the majority, according to the expert, passes from “amandatory revolution on the front of services for chronically ill patients, elderly and lonely patientsthose who cannot count on a family network, on caregivers or volunteers who assist them”. Pregliasco gives “the paradigmatic example of the diabetic: if his condition is not controlled, if he is not taken care of in the area, it ends up that when he is ill, he goes to the emergency room, is admitted to hospital and when he leaves he finds himself all over again”, sucked into “a vicious circle which does not restore his quality of life and which costs him and the system dearly”.
So what to do? “We need to put an end to the dualism which sees on one side the family doctor, overburdened and full of patients – observes the expert – and on the other the emergency room suffocated by requests which in more than a third of cases are improper. Sometimes it happens because the patient finds that going to the hospital is an easier solution, but other times it happens because the patient has no alternatives, because he can’t find anything between the GP and the hospital. Intermediate services are needed to overcome this gap”.
“The problem of defensive medicinethe one that fuels inappropriate prescriptions and which can contribute to improper access to the emergency room”, for Pregliasco is also linked to the fact that “today the doctor too often finds himself alone and cannot cope alone. If it becomes part of a system, yes.” It applies to family doctors in the area, but it also applies in the hospital to specialist figures who today are experiencing a profound crisis of vocation such as “the emergency doctor, the anesthesiologist-resuscitator, the surgeon. If everyone moved within a dense network of crucial support professions – which are nurses, but there are also others, from the physiotherapist to the occupational therapist or the perfusion technician, to name just a few – something could change. With the sharing of loads and the subdivision of roles the escape could be reversed, everyone’s work would be enhanced, more productive, efficient and peaceful”.
For this reason “the Community houses they are realities in which I believe a lot”, continues the doctor. “Just as I believe a lot in Rsa, the healthcare residences on which there must be a reevaluation. In pandemic they have been demonized so much, instead these are also places where services for the territory can be aggregated from a supply chain perspective. In the RSAs there are doctors, nurses and other professions: a small increase would be enough and they could become a pillar of local healthcare, ‘service centres’. There have been some experiences in this sense, but they should be extended, put into a system”. And given that “in residential care the private sector, especially the ETS” of Third Sector bodies, “accounts for over 80%”, it is This is where the “public-private partnership” desired by Pregliasco comes in. “With the direction of the public”, the specialist is convinced, this alliance could make the difference for the fate of the NHS.
The expert highlights some figures: “In 2022, hospital care in Italy was provided by 996 care institutions of various kinds, of which 51.3% were public and 48.7% were accredited private ones. In residential territorial care, i.e. the Rsa, the private , mostly Ets, are 84%; they are 71.3% in semi-residential care (day centers) and 78% in rehabilitation”.
It means that “already today in our country a large part of social and healthcare assistance is guaranteed by the two types of private individuals” on which Pregliasco would like the partnership he talks about to be founded: “Private non-profit ETS and accredited private individual. It is often criminalised, however the private sector can offer efficiency and flexibility in modulating the response to citizens’ needs. A private individual who obviously must not be left alone – he points out – it should not be left alonebut rather put in a position to provide quality services coordinated within an organic plan public direction“, repeats the doctor.
“I’m really surprised when the private, ideologically, wants to be erased. It’s a reality made up of structures and people. Has there been negativity and overflows? True, but it’s a political problem. For the service it performs and which it could perform even better, due to the potential it has to reduce the pressure that crushes the NHS – comments Pregliasco the academic, hospital director and voice of the Ets universe – the private is public”.
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